Histologic subtype impacts cancer-specific survival in patients with sarcomatoid-variant renal cell carcinoma treated surgically

Abstract

Purpose To report survival outcomes of patients treated surgically for sarcomatoid-variant renal cell carcinomas (sRCC) and to assess whether the underlying histologic subtype is an independent predictor of outcome. Methods One hundred and fifty-one patients underwent surgery at a referral center between 1991 and 2014 and had sRCC in final pathology. Kaplan–Meier curves for metastasis-free survival and cancer-specific survival (CSS) were calculated, and the log-rank test assessed differences between clear cell sRCC and nonclear cell sRCC. Cox regression models were generated to test the prognostic value of histologic subtype. Results Of 151 patients, 120 (79 %) had clear cell sRCC and 31 (21 %) had nonclear cell sRCC. Ninety-eight (65 %) patients had M0/Mx disease at presentation. Among those M0/Mx patients, metastasis-free survival probabilities were 49 % at 2 years [95 % confidence interval (CI) 38–60] and 39 % at 5 years (95 % CI 28–50), while CSS probabilities were 50 % at 2 years (95 % CI 41–58) and 32 % at 5 years (95 % CI 24–41). There was no significant difference in metastasis-free survival between clear cell and nonclear cell sRCC (p = 0.8). However, patients with nonclear cell sRCC had significantly lower CSS than patients with clear cell sRCC (p = 0.035). In multivariable analyses, nonclear cell sRCC conferred a higher risk of cancer-specific death compared with clear cell sRCC (HR 2.30, 95 % CI 1.38–3.82, p = 0.001). Conclusions In a cohort of patients treated surgically, the underlying histologic subtype of sRCC had an impact on CSS. These results present valuable information for individual counseling and patient selection in clinical trials.

Impact of sarcomatoid differentiation and rhabdoid differentiation on prognosis for renal cell carcinoma with vena caval tumour thrombus treated surgically

“…Furthermore, we found histologic subtype to be a significant predictor of PFS and CSS, in keeping with previous studies [24,25]. However, studies of grade 4 RCC accounting for sarcomatoid differentiation and/or rhabdoid differentiation failed to show an independent association between histologic subtype and prognosis [18,20].…”

Ki-67 index and percentage of sarcomatoid differentiation were two independent prognostic predictors in sarcomatoid renal cell carcinoma

“…A majority of previous studies have attempted to risk stratify patients diagnosed with sRCC based on pathological features. 1 , 2 , 4 – 6 Similarly, a prior study that was reported by Kim et al 6 also found this results, in cM 0 setting, the tumors harboring much more %SD were more likely to suffer progression of disease and assert greater influence on OS. In their study, 50% as a cut-off point for %SD was not continue to analyzed when just found that 25% of SD can observed different influence on OS, in addition, Ki-67 index was not included in their study.…”

“…The histological features of SD can be observed in all types of RCC 25 ; ccRCC is the most common histological subtype, which accounts for about 65%–79% of all histological subtype with sarcomatoid dif ferentiation. 1 , 2 , 5 – 8 , 18 Nguyen et al 2 showed that histological subtype was associated with cancer-specific survival ( P =0.001) but not associated with distant metastasis ( P =0.8) in patients with sRCC and found that patients with ncRCCs were more likely to die from sRCC (HR: 2.3: 95% CI: 1.38–3.82) than ccRCC. In the targeted therapy period, Golshayan et al 17 found that patients with metastatic sRCC with underlying histological subtype of ccRCC were more likely to respond to VEGF-targeted therapy.…”

“…Sarcomatoid differentiation (SD) in renal cell carcinoma (RCC) is an indicator of poor prognosis 1 , 2 and is more likely to present with advanced disease at first presentation. 1 , 3 – 7 Sarcomatoid RCC (sRCC) was not considered a separate RCC type currently, since it can be observed across all histological types in either clear-cell RCC (ccRCC) or nonclear-cell RCC (ncRCC).…”

“…Several clinicopathological characteristics were reported to be associated with the poor prognosis, and more recent studies have focused on molecular and genomic characteristics of sRCC 1 , 2 , 5 – 7 , 9 ; however, some risk features were not observed because histological criteria were changed, and a larger proportion of patients with clinical distant metastasis (cM 1 ) were in prior studies, most of which included patients from a period of at least a decade earlier. Nowadays, because of wide use of regular physical examination by abdominal imaging technologies, this may contribute to increase in the diagnosis of patients with no clinical distant metastasis (cM 0 ), and there exists no commonly accepted prognostic nomogram for clinicians in this new period.…”